NICE issues guidelines on asthma

The National Institute for Health and Care Excellence has published new guidelines designed to improve the diagnosis and management of asthma.

The Institute is recommending objective testing - including spirometry and FeNO (fractional exhaled nitric oxide) tests - alongside clinical assessment to help diagnose the condition in the primary care setting.

These tests will “help to achieve more accurate diagnosis” and therefore more effective treatment, it says.

Healthcare professionals currently check for signs and symptoms of the condition for diagnosis, but these are not always present and so use of objective testing with spirometry and FeNO should offer “a significant enhancement to current practice,” said Professor Mark Baker, director of the centre for guidelines at NICE.

He did note that additional infrastructure and training for this would be needed in primary care, but suggested “new models of care, being developed locally, could offer the opportunity to implement these recommendations,” which might involve “establishing diagnostic hubs to make testing efficient and affordable.”

He also said that the investment and training required to implement the new guidance “will take time”, but that, “in the meantime, primary care services should implement what they can of the new guidelines, using currently available approaches to diagnosis until the infrastructure for objective testing is in place.”

NICE estimates that the new recommendation could save the NHS some £10 to £15 million over a five-year period, mainly through reducing unnecessary prescriptions.

“There is no ‘gold standard’ test that can give a definitive diagnosis. This can lead to people having treatments they may not need, or to a missed diagnosis in people who do have asthma,” commented Andrew Menzies-Gow, consultant in respiratory medicine at the Royal Brompton and Harefield NHS Foundation Trust and co-chair of the guideline committee.

“Our recommendations will help tackle inappropriate diagnosis and ensure that if a diagnosis is given, that the person is monitored to ensure their symptoms still indicate asthma.”

With regard to management of the disease, NICE advises that patients unable to gain good control of their symptoms using a ‘brown or orange’ preventer inhaler regularly should now be offered a leukotriene receptor antagonist (LTRA) tablet with a preventer inhaler before they are given long acting beta-agonist (LABA) treatment.

The move could save the NHS an estimated £2 million a year for every 10,000 people who take up the new recommendation, NICE says.

In 2016 a study led by the Asthma UK Centre for Applied Research at The University of Edinburgh, concluded that asthma kills at least three people a day and costs the UK health service at least £1.1 billion a year.

The research also revealed that at least £666 million is spent on asthma-related prescription each year, while £160 million goes on GP consultations, £143 million on disability claims and £137 million on hospital care.